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Upper Tract Urothelial Cancers at Tzu-Chi, Hualien

Upper Tract Urothelial Cancers at Tzu-Chi, Hualien. By Wei-Min Tsai. 演講主軸 : 病歷寫作. Review of charts Specify dates of diagnosis and definitive treatment, especially cancers Specify clinical and pathological stages, TNM system Specify dates and sites of progression Accuracy.

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Upper Tract Urothelial Cancers at Tzu-Chi, Hualien

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  1. Upper Tract Urothelial Cancers at Tzu-Chi, Hualien By Wei-Min Tsai

  2. 演講主軸: 病歷寫作 • Review of charts • Specify dates of diagnosis and definitive treatment, especially cancers • Specify clinical and pathological stages, TNM system • Specify dates and sites of progression • Accuracy

  3. Computerized Charts

  4. Dreams of Clinical Researcher • Searchable pathology reports including histology, dates and stages • Cancer registry at least for Tzu-Chi hospital • Searchable computerized charts of any random terms like that in Medline • Searchable laboratory results • Specific tests • Specified ranges

  5. Upper Tract TCC at Tzu-Chi, Hualien • From 1989/5 to 2006/8 • 125 cases diagnosed as renal or ureteral transitional cell carcinoma (TCC) • Charts not found for 14 cases • Clinical features, pathological reports reviewed and compared to those in textbook (Smith’s General Urology)

  6. Upper Tract TCC at Tzu-Chi, Hualien • Epidemiology • Average annual incidence for bladder cancer: 6.3/100,000 (377 cases in 17 years, population in Hualien 347,298) • Average annual incidence for bladder cancer in Taiwan 6.4/100,000 (from 1993 to 2001) • Average annual incidence for upper tract TCC in Hualien: 2.1/100,000 (7 cases yearly at Tzu-Chi, Hualien, 21% from Taitung)

  7. Upper Tract TCC at Tzu-Chi, Hualien • Age at diagnosis: 68.4 years (range from 33 to 93) • Mean age at diagnosis 65years • Male to female ratio: 0.95:1 (54:57) • Male:female ratio 2-4:1 (Babaian and Johnson, 1980; Hawtry, 1976) • Male:female ratio 1:1.3 (高醫 Chou and Huang, 1999) • Male to female: 2.47:1 (2000, Taiwan, 膀胱癌) • Bladder : renal pelvic : ureteral carcinomas: 6.1:1.1:1 (377:66:62) • 51:3:1 (Williams and Mitchell, 1973) • 8:0.9:1.1 (高醫 Chou and Huang, 1999)

  8. Upper Tract TCC at Tzu-Chi, Hualien • Developing bladder TCC concomitantly or afterwards: 34.2% (38/111) • 30-50% at risk • Developing contralateral upper tract TCC: 5.4% (6/111) • 2-4% at risk • Primary bladder TCC developing upper tract TCC: 1.4% (5/356) • <2% (Oldbring et al., 1989)

  9. Upper Tract TCC at Tzu-Chi, Hualien • Right: left: bilateral 52:53:2 • Symptoms: • Gross hematuria 66.7% (74/111) • Flank pain 17.1% (18/111) • Hydronephrosis 7.2% ( 8/111) • Treatment: • Nephroureterectomy 72.1% (80/111) • Nephrectomy 8.1% ( 9/111) • Segmental resection 5.4% ( 6/111)

  10. Upper Tract TCC at Tzu-Chi, Hualien • 13 cases (11.7%) had dialysis history 0.5 months to 14 years before diagnosis. • 2 cases had renal transplantation 2 to 13 years before diagnosis • 3 cases had 2nd cancers including hepatocellular carcinoma, cholangiocarcinoma and laryngeal cancer

  11. Staging of Upper Tract TCC at Tzu-Chi, Hualien

  12. Characteristics of Upper Tract TCC at Tzu-Chi, Hualien

  13. 感謝Dr. 陳嘉彥Ms 李惠晴病歷室病理科

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